Can psychopathy be "cured"?
When psychologists talk to someone about what psychopathy is and what it is not with someone, there are many questions that arise. There is one that always ends up coming out, since it may be the most interesting of all. Is it possible to treat these people psychologically effectively? Some talk about treating and others talk about healing, which are very different things.
For this article we are going to talk about what we know today about the prognosis of psychopathy from a clinical point of view. Remember that science is knowledge that constantly mutates, and what we know today may not be so true tomorrow. Made the warnings, let's see what the meta-analyzes say.
- Related article: "Why is it so easy to fall in love with psychopaths?"
Ways to understand psychopathy
Unfortunately, Diagnostic manuals do not recognize psychopathy as a clinical entity . While these labels have many detractors - and rightly so - there is something they do serve. When the criteria of a disorder appear in a clear, exhaustive and orderly manner, this allows it to be investigated. And any research group that takes these criteria as reference, with almost total certainty will be studying the same phenomenon.
Psychopathy does not have this point of reference, so that each research group may be studying different definitions of psychopathy. There have been fruitful attempts to combine definitions and understand psychopathy as a set of traits that tend to occur at the same time. Perhaps the most widespread is that of Hervey Cleckley, who describes in an extensive way the clinical characteristics of the psychopath.
Robert Hare, later, identifies two factors in these descriptions main: to use others in a selfish, emotionally cold, hard and without remorse and on the other hand a chronically unstable type of life, marked by the transgression of standards and socially deviant.
Naturally, research about the effectiveness of treatment in psychopathy depends to a large extent on how we understand it. While most research uses the best known criteria, we must bear in mind that there is a part of the trials that may have measured psychopathy in different terms.
Is it incurable psychopathy?
Any student of psychology who has touched personality disorders has a kind of automatic spring that causes him to answer this question with a resounding "yes". There is a widespread belief that psychopathy is impossible to eradicate , something that also happens with antisocial personality disorder.
Effectively personality disorders are incurable, they do not remit in their entirety because they are exaggerated manifestations of normal personality traits. And in the same way that the personality is mutable to some extent , rigid personality patterns are also permeable only to a certain extent.
It is at this point that many times a leap of faith is made that is not entirely justified. That a mental disorder never remits does not mean that it can not respond to treatment. This is why we talk about treating, and not about healing. The truth is that the evidence on the treatment of psychopathy is not so strong.
The notion that this disorder is intractable may have originated through the psychoanalytic current , which suggests that personality is formed during the first 5 or 6 years of development and that it remains practically unchanged. But even within psychoanalysis this has been changing and the possibility of modification is conceived.
Hare himself proposed a theory of psychopathy that justified his status as "intractable". In this first theory says that psychopaths suffer an injury to the limbic system (located in the brain) that prevents them from inhibiting or interrupting their behavior. This also predicts that psychopaths are insensitive to punishment, that they never learn that an action can bring bad consequences. In a later revision of this theory, Hare described psychopaths as emotionally insensitive , with more difficulties to process the emotions of others.
What do the studies say?
All theory remains in speculation when we talk about therapeutic efficacy. When we want to find out if a disorder or phenomenon responds to different forms of treatment, the best way to find out is to put this hypothesis to the test.
Numerous research groups have shed the burden of clinical pessimism on psychopathy and carried out clinical trials to assess the viability of the treatments.
Surprisingly, most articles address the problem of psychopathy from psychoanalysis.Almost everyone understands the phenomenon as described by Cleckley, except for a few rehearsals. The cases treated by psychoanalytic therapy show a certain therapeutic success with respect to the control groups. This finding points in the direction that therapies focused on insight and on Disease awareness They could be beneficial for psychopaths.
Cognitive-behavioral therapies seem to be slightly more effective than psychoanalytic therapies. These therapies addressed issues such as thoughts about oneself, about others and about the world. In this way, some of the most dysfunctional characteristic features are treated. When the therapist combines the cognitive-behavioral approach and the insight-centered approach even higher therapeutic success rates are achieved .
The use of therapeutic communities has also been tried, but their results are only slightly higher than those of the control group. This is not surprising, because the therapeutic communities have little direct contact between therapist and client, which is what the psychopath really needs.
The use of medication to treat symptoms and behaviors characteristic of psychopathy, in the absence of a greater number of clinical trials, is promising. Unfortunately, the methodological precariousness of the studies in this regard and the small number of articles do not allow us to draw final conclusions on this issue.
- Related article: "Types of psychological therapies"
Dismantling the myth
It is not necessary to believe fervently in the results of studies to realize that psychopathy is far from untreatable . Although we do not have specific programs that address all the dysfunctional aspects of the psychopath, we do have therapeutic tools to end the most maladaptive behaviors. If these therapeutic benefits are maintained over time it is something that remains in the air.
One of the fundamental problems that occurs in the treatment of psychopathy, as in other personality disorders, is that it is uncommon for the client to want to go to therapy . And even in the strange case that they come of their own volition, they are often resistant to change. At the end of the day we are going to ask the patient to introduce a series of personality changes that are not at all easy to implement and threaten their own identity.
With these patients it is necessary Do an intense work of awareness of illness and motivation for the previous change to the therapy itself. This extra effort wears both the patient and the therapist, which often ends up abandoning or unfairly labeling the patient as untreatable. The truth is that if we can not change a psychopath it is only because we have not yet found a way to achieve it.